Strategies to Increase Use of Postpartum Care Services for Women in Rural Malawi

Objective To explore strategies to improve use of skilled care after childbirth by examining reasons that women in rural Malawi (a) sought postpartum care from a health care facility after birth, (b) intended to seek future care in that health care facility, and (c) used postpartum care from a traditional birth attendant in the past. Maternal mortality rates remain unacceptably high in subSaharan Africa. The World Health Organization recommends using skilled care before, during, and after childbirth to decrease maternal death rates. However, many women in the region do not receive skilled postpartum care. Design Descriptive, cross-sectional study. Setting Rural communities in the Ntcheu district of Malawi. Patients/Participants A convenience sample of women who were subsistence farmers, 18 years and older, who were able to communicate in Chichewa and who gave birth in the past year. Methods Face-to-face interviews were conducted with 70 women in their homes, using open-ended questions administered in Chichewa. Data were analyzed using descriptive statistics. Participant reasons were ranked by percentage of women mentioning these reasons. Results Sixty-eight of the 70 women returned to a health care facility for their postpartum visit with top three reasons being advised by midwife to return (35%), wanted baby to be examined (29%), and for their own well being (18%). About 54 women said they would return to the health care facility for future care, citing their satisfaction with care (23%), midwife kindness (16%), and short distance (16%) as the top three reasons. Twenty-one percent of women (n ¼ 15) had received prior postpartum care from a traditional birth attendant because there were no health care facilities in the area, a traditional birth attendant was the only option (43%), the hospital was too far (29%), and they lacked awareness about services (14%). Implications for Nursing Practice Health care facility availability and accessibility are important initial steps to ensuring access to care. Advice to return for postpartum visits and education on importance of postpartum checkups for both mother and baby may improve use of services. Women’s perceptions of midwife kindness and satisfaction with care are important factors that can influence whether women seek additional future care in health care facilities. Interventions can focus on improving midwife attitudes toward patients

Strategies to Improve Patient Care by Increasing Midwives\u27 Knowledge of Postpartum Care

Objective Postpartum care is critical in preventing and reducing maternal deaths. In Ghana, midwives are the primary maternity care providers; therefore, their knowledge of postpartum care determines the quality of care provided to women after childbirth. However, few studies have examined midwives’ knowledge of postpartum care in sub-Saharan Africa. This study explores knowledge of postpartum care among midwives in order to develop interventions to improve patient care after childbirth. Design Cross-sectional survey. Setting Four hospitals in Tamale, Ghana. Patients/Participants A convenience sample of midwives, 18 years and older, employed in the four hospitals. Methods A cross-sectional survey of 246 midwives was conducted in the four main hospitals of Tamale, Ghana. Three of the hospitals were government facilities and one was a mission hospital. The study was guided by the Three Delays Framework, specifically focusing on Phase III delays of provision of adequate care at a health care facility. Data were collected using an anonymous postpartum-care knowledge questionnaire by the Johns Hopkins Program for International Education in Gynecology and Obstetrics. Data were analyzed in Stata statistical software using descriptive statistics. Results Most of the midwives were women (98%). The mean age of midwives was 31.87 years. About 40.4% had a certificate in midwifery, 46.9% had a diploma in midwifery, and 12.7% had a bachelor’s in midwifery. The percentage of midwives able to correctly answer each question are as follows: 41.63% on location of fundus, 46.53% on postpartum examination, 57.55% on care during the first 2 hours after birth, 62.04% on obtaining history during a postpartum visit, 67.67% on obtaining information on patient problems during a postpartum visit, 73.47% on timing of postpartum visits, 74.29% on infection-prevention practice, 75.92% on danger signs, 77.14% on breastfeeding, and 84.90% on nutrition for breastfeeding mother. Beside their midwife education, 42% of midwives had never received any continuing education or in-service training in postpartum care. Implications for Nursing Practice Findings suggest that the majority of midwives are not knowledgeable about location of fundus, postpartum examination, and care during the first 2 hours after birth. However, most midwives are knowledgeable about breastfeeding. Findings suggest a need for refresher training to educate midwives on how to care for postpartum patients

Improving the Quality of Postpartum Care in Ghana: Protocol for a Parallel Randomized Controlled Trial

BackgroundAlthough the postpartum period poses substantial risks and can result in significant maternal morbidity and mortality, postpartum care of the mother receives much less attention in transitional countries. ObjectiveWe describe the protocol for a randomized controlled trial to implement and evaluate a postpartum care delivery model titled Focused-PPC (Focused Postpartum Care). MethodsFocused-PPC is an integrated group postpartum care model that meets the clinical care, education, and support needs of mothers up to 1 year after birth. The Focused-PPC intervention is a parallel randomized controlled trial with a total of 192 postpartum women at 4 health centers in Tamale, Ghana. Participants will be randomized into 1 of 2 trial arms at a 1:1 allocation ratio: (1) the control arm, which receives the standard postnatal care currently delivered in health facilities, or (2) the intervention arm, which receives the Focused-PPC model of care. Women enrolled in the intervention arm will receive postpartum clinical assessments and education for the first 6 weeks and will continue to receive education, measures of vital signs, and peer support for 12 months post partum during child welfare visits. Led by trained midwives, each postpartum group in the intervention arm will meet at 1-2 weeks, 6 weeks, and monthly thereafter for up to 1 year post partum, following the Ghana Health Service postnatal care schedule. ResultsThe Focused-PPC guide, data collection tools, and audiovisual education materials were successfully developed and translated into the local language. We have enrolled and conducted baseline surveys for 192 women (sample size met) in the Focused-PPC trial who have been randomized into intervention and control arms. We have established a total of 12 Focused-PPC groups in the intervention arm, 3 groups from each site, all of which have sessions underway. ConclusionsFocused-PPC has the potential to change the postpartum care delivery model in Ghana and other countries in sub-Saharan Africa and beyond. Trial RegistrationClinicalTrials.gov NCT05280951; https://clinicaltrials.gov/study/NCT05280951 International Registered Report Identifier (IRRID)DERR1-10.2196/4751

Water, sanitation, and hygiene (WASH) insecurity will exacerbate the toll of COVID-19 on women and girls in low-income countries

The novel coronavirus disease (COVID-19) pandemic is having a significant global impact on livelihoods, health, and general well-being. This policy brief argues that in low-income countries (LICs) where water, sanitation, and hygiene (WASH) insecurity is widespread and closely entangled with poverty and other vulnerabilities, COVID-19 will have a particularly devastating impact on women and girls because they bear the disproportionate burden of water collection, sanitation, hygiene, and family welfare ‒ responsibilities embedded in longstanding sociocultural norms. WASH insecurity refers to the physical and relational inequities in WASH access. Using three pathways ‒ reproductive and perinatal health, cultural norms and the risk of COVID-19 infections, and physical and mental health ‒ we discuss how WASH insecurity will worsen the impact of COVID-19 on women and girls in LICs

Husband\u27s Knowledge and Attendance at Wives\u27 Postpartum Care among Rural Farmers

We examined husbands’ knowledge and attendance at their wives’ postpartum visit in a sample of rural husband-and-wife farmer dyads in central Malawi. A cross-sectional matched-pairs survey of 70 husband-and-wife farmer dyads, who lived in rural communities in Ntcheu district, and had a live birth in the past year was conducted. Data were collected using an interviewer-administered, structured postpartum questionnaire adapted from WHO Safe Motherhood Needs Assessment Questionnaires. Many husbands did not know about postpartum assessments and education their wives received from health facilities. Percent agreement between dyads’ responses was lower on questions referring to assessments than to education. The odds of reporting that the woman received postpartum assessments were greater among husbands than among wives. Fifty-nine percent of husbands did not go with their wives for 1-week postpartum visits. Top three reasons for not attending visits were: at work, out of town, and did not see the need

Knowledge of postpartum care and postbirth warning signs among midwives in Ghana

Background In Ghana, midwives are the primary maternity care practitioners. Their knowledge of postpartum care is critical for preventing and reducing maternal deaths because it affects the quality of care provided to women. In addition, midwives’ knowledge of postbirth warning signs is important for early identification and management of complications. This study assessed midwives’ knowledge of postpartum care and postbirth warning signs to develop interventions to improve patient care. Methods A cross‐sectional survey of 246 midwives was conducted in the four main hospitals of Tamale, Ghana. Data were collected using a postpartum care knowledge questionnaire developed by JHPIEGO. Data were analyzed in SAS version 9.4 using descriptive, bivariate, and multivariate statistics. Results Mean age of midwives was 31.9 years. The percentage of midwives who responded correctly to each postpartum care question ranged from 41.6% to 84.9%. Most midwives were knowledgeable about breastfeeding—however, knowledge about fundus location, postpartum examination, and care during first 2 hours postpartum was low. Hospital was associated with knowledge of postpartum care (P \u3c .001). Only 28.1% of midwives identified all nine warning signs of complications. Most midwives could identify severe bleeding, severe headaches, and high temperature as warning signs—however, knowledge of warning signs of some life‐threatening complications such as chest pain, obstructed breathing, and thoughts of hurting oneself was low. More years of experience was associated with better knowledge of postbirth warning signs (P = .03). Discussion Findings suggest a need for additional training of midwives in how to care for postpartum patients and accurately identify warning signs for life‐threatening complications

MSCA Health and Healthcare Inequities Forum

Project Space for MSCA Health and Healthcare Inequities Workatho